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This year’s Match Day takes place on Friday, March 18.

Do you remember when you opened your letter? Do you know someone who is matching this year? Share your stories with SHM on Twitter @SHMLive and use the official Match Day 2016 hashtag, #Match2016, and #FutureofHospitalMedicine, plus encourage your students to do so as well. Follow along with the excitement and join in the conversation throughout the day.

It’s hard to believe, but Match Day 2017 is closer than you think. Fourth-year medical students can visit www.futureofhospitalmedicine.org for all of the resources needed to be successful, including:

• Residency match application checklist
• Application tool kit
• An overview of matching for fellowship applicants
• National Residency Matching Program FAQs
• Information on how to register to match

This year’s Match Day takes place on Friday, March 18.

Do you remember when you opened your letter? Do you know someone who is matching this year? Share your stories with SHM on Twitter @SHMLive and use the official Match Day 2016 hashtag, #Match2016, and #FutureofHospitalMedicine, plus encourage your students to do so as well. Follow along with the excitement and join in the conversation throughout the day.

It’s hard to believe, but Match Day 2017 is closer than you think. Fourth-year medical students can visit www.futureofhospitalmedicine.org for all of the resources needed to be successful, including:

• Residency match application checklist
• Application tool kit
• An overview of matching for fellowship applicants
• National Residency Matching Program FAQs
• Information on how to register to match

This year’s Match Day takes place on Friday, March 18.

Do you remember when you opened your letter? Do you know someone who is matching this year? Share your stories with SHM on Twitter @SHMLive and use the official Match Day 2016 hashtag, #Match2016, and #FutureofHospitalMedicine, plus encourage your students to do so as well. Follow along with the excitement and join in the conversation throughout the day.

It’s hard to believe, but Match Day 2017 is closer than you think. Fourth-year medical students can visit www.futureofhospitalmedicine.org for all of the resources needed to be successful, including:

• Residency match application checklist
• Application tool kit
• An overview of matching for fellowship applicants
• National Residency Matching Program FAQs
• Information on how to register to match

It has been two years since the “Key Characteristics” was published in the Journal of Hospital Medicine.1 The SHM board of directors envisions the Key Characteristics as a tool to improve the performance of hospital medicine groups (HMGs) and “raise the bar” for the specialty.

At SHM’s annual meeting (www.hospitalmedicine2016.org) next month in San Diego, the Key Characteristics will provide the framework for the Practice Management Pre-Course (Sunday, March 6). The pre-course faculty, of which I am a member, will address all 10 principles of the Key Characteristics (see Table 1), including case studies and practical ideas for performance improvement. As a preview, I will cover Principle 6 and provide a few practical tips that you can implement in your practice.

For a more comprehensive discussion of all the Key Characteristics and how to use them, visit the SHM website (visit www.hospitalmedicine.org, then click on the “Practice Management” icon at the top of the landing page).

Characteristic 6.1

The HMG has systems in place to ensure effective and reliable communication with the patient’s primary care physician and/or other provider(s) involved in the patient’s care in the non-acute-care setting.

Practical tip: Your practice probably has administrative procedures in place to notify PCPs that their patient has been admitted to the hospital, using the electronic health record or secure email, if available, or messaging by fax/phone. But are you receiving vital information from the PCP’s office or from the nursing facility? Establish a protocol for obtaining key history, medication, and diagnostic testing information from these sources. One approach is to request this information when notifying the PCP of the patient’s admission.

Practical tip: Use the “grocery store test” to determine when to contact the PCP during the hospital stay. For example, if the PCP were to run into a family member of the patient in the grocery store, would the PCP want to have learned of a change in the patient’s condition in advance of the family member encounter?

Practical tip: Because reaching skilling nursing facility (SNF) physicians/providers (SNFists) can be challenging, hold an annual social event so that they can meet the hospitalists in your practice face-to-face. At the event, exchange cellphone or beeper numbers with the SNFists, and establish an explicit understanding of how handoffs will occur, especially for high-risk patients.

Characteristic 6.2

The HMG contributes in meaningful ways to the hospital’s efforts to improve care transitions.

Because of readmissions penalties, every hospital in the country is concerned with care transitions and avoiding readmissions. But HMGs want to know which interventions reliably decrease readmissions. The Commonwealth Fund recently released the results of a study of 428 hospitals that participated in national efforts to reduce readmissions, including the State Action on Avoidable Rehospitalizations (STAAR) and Hospital to Home (H2H) initiatives. The study’s primary conclusions were as follows:

• The only strategy consistently associated with reduced risk-standardized readmissions was discharging patients with their appointments already made.2 No other single strategy was reliably associated with a reduction.
• Hospitals that implemented three or more readmission reduction strategies showed a significant decrease in risk-standardized readmissions versus those implementing fewer than three.

Practical tip: Ensure patients leave the hospital with a PCP follow-up appointment made and in hand.

Practical tip: Work with your hospital on at least three definitive strategies to reduce readmissions.

Implement to Improve Your HMG

The basic and updated 2015 versions of the “Key Principles and Characteristics of an Effective Hospital Medicine Group” can be downloaded from the SHM website (visit www.hospitalmedicine.org, then click on the “Practice Management” icon at the top of the landing page). The updated 2015 version provides definitions and requirements and suggested approaches to demonstrating the characteristic that enables the HMG to conduct a comprehensive self-assessment.

In addition, there is a new tool intended for use by hospitalist practice administrators that cross-references the Key Characteristics with another tool, The Core Competencies for a Hospitalist Practice Administrator. TH

References

1. Cawley P, Deitelzweig S, Flores L, et al. The key principles and characteristics of an effective hospital medicine group: an assessment guide for hospitals and hospitalists. J Hosp Med. 2014;9(2):123-128.
2. Bradley EH, Brewster A, Curry L. National campaigns to reduce readmissions: what have we learned? The Commonwealth Fund website. Available at: commonwealthfund.org/publications/blog/2015/oct/national-campaigns-to-reduce-readmissions. Accessed December 28, 2015.

It has been two years since the “Key Characteristics” was published in the Journal of Hospital Medicine.1 The SHM board of directors envisions the Key Characteristics as a tool to improve the performance of hospital medicine groups (HMGs) and “raise the bar” for the specialty.

At SHM’s annual meeting (www.hospitalmedicine2016.org) next month in San Diego, the Key Characteristics will provide the framework for the Practice Management Pre-Course (Sunday, March 6). The pre-course faculty, of which I am a member, will address all 10 principles of the Key Characteristics (see Table 1), including case studies and practical ideas for performance improvement. As a preview, I will cover Principle 6 and provide a few practical tips that you can implement in your practice.

For a more comprehensive discussion of all the Key Characteristics and how to use them, visit the SHM website (visit www.hospitalmedicine.org, then click on the “Practice Management” icon at the top of the landing page).

Characteristic 6.1

The HMG has systems in place to ensure effective and reliable communication with the patient’s primary care physician and/or other provider(s) involved in the patient’s care in the non-acute-care setting.

Practical tip: Your practice probably has administrative procedures in place to notify PCPs that their patient has been admitted to the hospital, using the electronic health record or secure email, if available, or messaging by fax/phone. But are you receiving vital information from the PCP’s office or from the nursing facility? Establish a protocol for obtaining key history, medication, and diagnostic testing information from these sources. One approach is to request this information when notifying the PCP of the patient’s admission.

Practical tip: Use the “grocery store test” to determine when to contact the PCP during the hospital stay. For example, if the PCP were to run into a family member of the patient in the grocery store, would the PCP want to have learned of a change in the patient’s condition in advance of the family member encounter?

Practical tip: Because reaching skilling nursing facility (SNF) physicians/providers (SNFists) can be challenging, hold an annual social event so that they can meet the hospitalists in your practice face-to-face. At the event, exchange cellphone or beeper numbers with the SNFists, and establish an explicit understanding of how handoffs will occur, especially for high-risk patients.

Characteristic 6.2

The HMG contributes in meaningful ways to the hospital’s efforts to improve care transitions.

Because of readmissions penalties, every hospital in the country is concerned with care transitions and avoiding readmissions. But HMGs want to know which interventions reliably decrease readmissions. The Commonwealth Fund recently released the results of a study of 428 hospitals that participated in national efforts to reduce readmissions, including the State Action on Avoidable Rehospitalizations (STAAR) and Hospital to Home (H2H) initiatives. The study’s primary conclusions were as follows:

• The only strategy consistently associated with reduced risk-standardized readmissions was discharging patients with their appointments already made.2 No other single strategy was reliably associated with a reduction.
• Hospitals that implemented three or more readmission reduction strategies showed a significant decrease in risk-standardized readmissions versus those implementing fewer than three.

Practical tip: Ensure patients leave the hospital with a PCP follow-up appointment made and in hand.

Practical tip: Work with your hospital on at least three definitive strategies to reduce readmissions.

Implement to Improve Your HMG

The basic and updated 2015 versions of the “Key Principles and Characteristics of an Effective Hospital Medicine Group” can be downloaded from the SHM website (visit www.hospitalmedicine.org, then click on the “Practice Management” icon at the top of the landing page). The updated 2015 version provides definitions and requirements and suggested approaches to demonstrating the characteristic that enables the HMG to conduct a comprehensive self-assessment.

In addition, there is a new tool intended for use by hospitalist practice administrators that cross-references the Key Characteristics with another tool, The Core Competencies for a Hospitalist Practice Administrator. TH

References

1. Cawley P, Deitelzweig S, Flores L, et al. The key principles and characteristics of an effective hospital medicine group: an assessment guide for hospitals and hospitalists. J Hosp Med. 2014;9(2):123-128.
2. Bradley EH, Brewster A, Curry L. National campaigns to reduce readmissions: what have we learned? The Commonwealth Fund website. Available at: commonwealthfund.org/publications/blog/2015/oct/national-campaigns-to-reduce-readmissions. Accessed December 28, 2015.

It has been two years since the “Key Characteristics” was published in the Journal of Hospital Medicine.1 The SHM board of directors envisions the Key Characteristics as a tool to improve the performance of hospital medicine groups (HMGs) and “raise the bar” for the specialty.

At SHM’s annual meeting (www.hospitalmedicine2016.org) next month in San Diego, the Key Characteristics will provide the framework for the Practice Management Pre-Course (Sunday, March 6). The pre-course faculty, of which I am a member, will address all 10 principles of the Key Characteristics (see Table 1), including case studies and practical ideas for performance improvement. As a preview, I will cover Principle 6 and provide a few practical tips that you can implement in your practice.

For a more comprehensive discussion of all the Key Characteristics and how to use them, visit the SHM website (visit www.hospitalmedicine.org, then click on the “Practice Management” icon at the top of the landing page).

Characteristic 6.1

The HMG has systems in place to ensure effective and reliable communication with the patient’s primary care physician and/or other provider(s) involved in the patient’s care in the non-acute-care setting.

Practical tip: Your practice probably has administrative procedures in place to notify PCPs that their patient has been admitted to the hospital, using the electronic health record or secure email, if available, or messaging by fax/phone. But are you receiving vital information from the PCP’s office or from the nursing facility? Establish a protocol for obtaining key history, medication, and diagnostic testing information from these sources. One approach is to request this information when notifying the PCP of the patient’s admission.

Practical tip: Use the “grocery store test” to determine when to contact the PCP during the hospital stay. For example, if the PCP were to run into a family member of the patient in the grocery store, would the PCP want to have learned of a change in the patient’s condition in advance of the family member encounter?

Practical tip: Because reaching skilling nursing facility (SNF) physicians/providers (SNFists) can be challenging, hold an annual social event so that they can meet the hospitalists in your practice face-to-face. At the event, exchange cellphone or beeper numbers with the SNFists, and establish an explicit understanding of how handoffs will occur, especially for high-risk patients.

Characteristic 6.2

The HMG contributes in meaningful ways to the hospital’s efforts to improve care transitions.

Because of readmissions penalties, every hospital in the country is concerned with care transitions and avoiding readmissions. But HMGs want to know which interventions reliably decrease readmissions. The Commonwealth Fund recently released the results of a study of 428 hospitals that participated in national efforts to reduce readmissions, including the State Action on Avoidable Rehospitalizations (STAAR) and Hospital to Home (H2H) initiatives. The study’s primary conclusions were as follows:

• The only strategy consistently associated with reduced risk-standardized readmissions was discharging patients with their appointments already made.2 No other single strategy was reliably associated with a reduction.
• Hospitals that implemented three or more readmission reduction strategies showed a significant decrease in risk-standardized readmissions versus those implementing fewer than three.

Practical tip: Ensure patients leave the hospital with a PCP follow-up appointment made and in hand.

Practical tip: Work with your hospital on at least three definitive strategies to reduce readmissions.

Implement to Improve Your HMG

The basic and updated 2015 versions of the “Key Principles and Characteristics of an Effective Hospital Medicine Group” can be downloaded from the SHM website (visit www.hospitalmedicine.org, then click on the “Practice Management” icon at the top of the landing page). The updated 2015 version provides definitions and requirements and suggested approaches to demonstrating the characteristic that enables the HMG to conduct a comprehensive self-assessment.

In addition, there is a new tool intended for use by hospitalist practice administrators that cross-references the Key Characteristics with another tool, The Core Competencies for a Hospitalist Practice Administrator. TH

References

1. Cawley P, Deitelzweig S, Flores L, et al. The key principles and characteristics of an effective hospital medicine group: an assessment guide for hospitals and hospitalists. J Hosp Med. 2014;9(2):123-128.
2. Bradley EH, Brewster A, Curry L. National campaigns to reduce readmissions: what have we learned? The Commonwealth Fund website. Available at: commonwealthfund.org/publications/blog/2015/oct/national-campaigns-to-reduce-readmissions. Accessed December 28, 2015.

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Steve Harris, Esq., legal columnist for The Hospitalist, explains the ins and outs of a hospitalist contract.

Steve Harris, Esq., legal columnist for The Hospitalist, explains the ins and outs of a hospitalist contract.

Steve Harris, Esq., legal columnist for The Hospitalist, explains the ins and outs of a hospitalist contract.

Presenter: Tricia Marriott, PA-C, MPAS, MJ Health Law

Summary: Ms. Marriott brought humor to a detailed #HospMed16 presentation on the rules of reimbursement and Medicare requirements for physician assistants (PAs) and nurse practitioners (NPs). The session was packed with information regarding the Medicare regulations relating to PAs and NPs, as well as information from state Medicaid programs and commercial payors. The presentation continued with focusing on myth busters and misperceptions about PAs and NPs. These topics were reviewed in depth:

• PAs and NPs have been recognized as providers by Medicare since 1998, as demonstrated by Medicare citations provided to the audience.
• Supervision/collaboration, as defined by Medicare requirements.
• Medicare payment policy: “incident to” vs. “split/shared visit,” reviewing unacceptable shared visit documentation and unintended consequences of fewer shared visits.

The discussion provided detailed insight into how to address the question, “What about the 15% reduced Medicare reimbursement for PAs and NPs?” An analytical approach to answering this question was provided as it relates to inpatient services, observation services, critical care services, and consultations. At the end of the talk, the audience was very engaged, and a lively Q&A ensued past the scheduled time. TH

Presenter: Tricia Marriott, PA-C, MPAS, MJ Health Law

Summary: Ms. Marriott brought humor to a detailed #HospMed16 presentation on the rules of reimbursement and Medicare requirements for physician assistants (PAs) and nurse practitioners (NPs). The session was packed with information regarding the Medicare regulations relating to PAs and NPs, as well as information from state Medicaid programs and commercial payors. The presentation continued with focusing on myth busters and misperceptions about PAs and NPs. These topics were reviewed in depth:

• PAs and NPs have been recognized as providers by Medicare since 1998, as demonstrated by Medicare citations provided to the audience.
• Supervision/collaboration, as defined by Medicare requirements.
• Medicare payment policy: “incident to” vs. “split/shared visit,” reviewing unacceptable shared visit documentation and unintended consequences of fewer shared visits.

The discussion provided detailed insight into how to address the question, “What about the 15% reduced Medicare reimbursement for PAs and NPs?” An analytical approach to answering this question was provided as it relates to inpatient services, observation services, critical care services, and consultations. At the end of the talk, the audience was very engaged, and a lively Q&A ensued past the scheduled time. TH

Presenter: Tricia Marriott, PA-C, MPAS, MJ Health Law

Summary: Ms. Marriott brought humor to a detailed #HospMed16 presentation on the rules of reimbursement and Medicare requirements for physician assistants (PAs) and nurse practitioners (NPs). The session was packed with information regarding the Medicare regulations relating to PAs and NPs, as well as information from state Medicaid programs and commercial payors. The presentation continued with focusing on myth busters and misperceptions about PAs and NPs. These topics were reviewed in depth:

• PAs and NPs have been recognized as providers by Medicare since 1998, as demonstrated by Medicare citations provided to the audience.
• Supervision/collaboration, as defined by Medicare requirements.
• Medicare payment policy: “incident to” vs. “split/shared visit,” reviewing unacceptable shared visit documentation and unintended consequences of fewer shared visits.

The discussion provided detailed insight into how to address the question, “What about the 15% reduced Medicare reimbursement for PAs and NPs?” An analytical approach to answering this question was provided as it relates to inpatient services, observation services, critical care services, and consultations. At the end of the talk, the audience was very engaged, and a lively Q&A ensued past the scheduled time. TH

Presenter: Julie Hollberg, MD

Summary: Dr. Julie Hollberg, the chief medical information officer for Emory Healthcare, presented an overview of three pressing health information technology (IT) concerns at Hospital Medicine 2016, the “Year of the Hospitalist.” These issues are the use of copy-and-paste functions in electronic charting, alert fatigue, and patient access to electronic charts.

Dr. Hollberg states the key to leveraging healthcare IT to improve the patient and clinician experience is to coordinate people, technology, and the process. She relates that electronic note quality is poor due to lost narratives, “note bloat” (unnecessary text and data), and the use of copy-and-paste.

However, hospitalists themselves are essential in improving documentation. “We have 100% control of what goes into the note,” she describes. Some 90% of residents and attendings use copy-and-paste often. Most of the physicians agree the use of copy-and-paste increases inconsistencies, but 80% of physicians desire to continue the practice. The need for copy-and-paste should decrease as EMRs advance and expectations of note content is more broadly communicated.

Alerts are designed to improve patient safety and are a Meaningful Use initiative. The goal of clinical decision support is to provide the right information to the right person at the right time. However alert fatigue is a concern. Recommendations to address alert fatigue include making alerts non-interruptive, tier basing the alerts by severity, and decreasing the frequency of drug interaction alerts.

Dr. Hollberg also described the benefits of patient access to healthcare information on web portals. These benefits lead to improved patient engagement. Most physician concerns about open access has not been seen in actual practice. For example, only 1-8% of patients say that access to notes causes confusion, worry, or offense.

Key Takeaways:

1. Use of copy-and-paste creates “note bloat” and inconsistencies. The practice is discouraged.
2. Patients prefer access to healthcare information on portals. The benefit to improved access is greater patient engagement.
3. While alert fatigue is a concern, clinicians should still read alerts! TH

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston and a former member of Team Hospitalist.

Presenter: Julie Hollberg, MD

Summary: Dr. Julie Hollberg, the chief medical information officer for Emory Healthcare, presented an overview of three pressing health information technology (IT) concerns at Hospital Medicine 2016, the “Year of the Hospitalist.” These issues are the use of copy-and-paste functions in electronic charting, alert fatigue, and patient access to electronic charts.

Dr. Hollberg states the key to leveraging healthcare IT to improve the patient and clinician experience is to coordinate people, technology, and the process. She relates that electronic note quality is poor due to lost narratives, “note bloat” (unnecessary text and data), and the use of copy-and-paste.

However, hospitalists themselves are essential in improving documentation. “We have 100% control of what goes into the note,” she describes. Some 90% of residents and attendings use copy-and-paste often. Most of the physicians agree the use of copy-and-paste increases inconsistencies, but 80% of physicians desire to continue the practice. The need for copy-and-paste should decrease as EMRs advance and expectations of note content is more broadly communicated.

Alerts are designed to improve patient safety and are a Meaningful Use initiative. The goal of clinical decision support is to provide the right information to the right person at the right time. However alert fatigue is a concern. Recommendations to address alert fatigue include making alerts non-interruptive, tier basing the alerts by severity, and decreasing the frequency of drug interaction alerts.

Dr. Hollberg also described the benefits of patient access to healthcare information on web portals. These benefits lead to improved patient engagement. Most physician concerns about open access has not been seen in actual practice. For example, only 1-8% of patients say that access to notes causes confusion, worry, or offense.

Key Takeaways:

1. Use of copy-and-paste creates “note bloat” and inconsistencies. The practice is discouraged.
2. Patients prefer access to healthcare information on portals. The benefit to improved access is greater patient engagement.
3. While alert fatigue is a concern, clinicians should still read alerts! TH

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston and a former member of Team Hospitalist.

Presenter: Julie Hollberg, MD

Summary: Dr. Julie Hollberg, the chief medical information officer for Emory Healthcare, presented an overview of three pressing health information technology (IT) concerns at Hospital Medicine 2016, the “Year of the Hospitalist.” These issues are the use of copy-and-paste functions in electronic charting, alert fatigue, and patient access to electronic charts.

Dr. Hollberg states the key to leveraging healthcare IT to improve the patient and clinician experience is to coordinate people, technology, and the process. She relates that electronic note quality is poor due to lost narratives, “note bloat” (unnecessary text and data), and the use of copy-and-paste.

However, hospitalists themselves are essential in improving documentation. “We have 100% control of what goes into the note,” she describes. Some 90% of residents and attendings use copy-and-paste often. Most of the physicians agree the use of copy-and-paste increases inconsistencies, but 80% of physicians desire to continue the practice. The need for copy-and-paste should decrease as EMRs advance and expectations of note content is more broadly communicated.

Alerts are designed to improve patient safety and are a Meaningful Use initiative. The goal of clinical decision support is to provide the right information to the right person at the right time. However alert fatigue is a concern. Recommendations to address alert fatigue include making alerts non-interruptive, tier basing the alerts by severity, and decreasing the frequency of drug interaction alerts.

Dr. Hollberg also described the benefits of patient access to healthcare information on web portals. These benefits lead to improved patient engagement. Most physician concerns about open access has not been seen in actual practice. For example, only 1-8% of patients say that access to notes causes confusion, worry, or offense.

Key Takeaways:

1. Use of copy-and-paste creates “note bloat” and inconsistencies. The practice is discouraged.
2. Patients prefer access to healthcare information on portals. The benefit to improved access is greater patient engagement.
3. While alert fatigue is a concern, clinicians should still read alerts! TH

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston and a former member of Team Hospitalist.

HM16 Presenters: Dr. Scott Rissmiller, Dr. Steve Deitelzweig, Dr. Jerome Siy, Dr. Thomas Mcllraith, and Dr. Michael Reitz

Summary: This session at #HospMed16 explored lessons learned from five hospitalist leaders across the country about improving hospitalist practice through enhancing hospitalist engagement, group communication, and leadership development. It was proposed that the “new” value equation is [Engagement * (quality/cost)] = Value. Engagement is the multiplier of value. The speakers highlighted the following:

Build a Plan : Approach engagement like any other business plan with metrics, accountability, and “S.M.A.R.T." goals.

Build Trust: Visibility breeds credibility. Credibility breeds Trust. Trust encourages Engagement.

Build Transparency: Keep communication simple and be sure that it’s helpful information.

Build Leaders: All hospitalists are leaders. Strong leadership skills promote effective communication across the system. Nurture leadership skills for the right level of leadership, to find the right seat on the bus.

Build Celebrations: Celebrate successes, and learn from failure. TH

HM16 Presenters: Dr. Scott Rissmiller, Dr. Steve Deitelzweig, Dr. Jerome Siy, Dr. Thomas Mcllraith, and Dr. Michael Reitz

Summary: This session at #HospMed16 explored lessons learned from five hospitalist leaders across the country about improving hospitalist practice through enhancing hospitalist engagement, group communication, and leadership development. It was proposed that the “new” value equation is [Engagement * (quality/cost)] = Value. Engagement is the multiplier of value. The speakers highlighted the following:

Build a Plan : Approach engagement like any other business plan with metrics, accountability, and “S.M.A.R.T." goals.

Build Trust: Visibility breeds credibility. Credibility breeds Trust. Trust encourages Engagement.

Build Transparency: Keep communication simple and be sure that it’s helpful information.

Build Leaders: All hospitalists are leaders. Strong leadership skills promote effective communication across the system. Nurture leadership skills for the right level of leadership, to find the right seat on the bus.

Build Celebrations: Celebrate successes, and learn from failure. TH

HM16 Presenters: Dr. Scott Rissmiller, Dr. Steve Deitelzweig, Dr. Jerome Siy, Dr. Thomas Mcllraith, and Dr. Michael Reitz

Summary: This session at #HospMed16 explored lessons learned from five hospitalist leaders across the country about improving hospitalist practice through enhancing hospitalist engagement, group communication, and leadership development. It was proposed that the “new” value equation is [Engagement * (quality/cost)] = Value. Engagement is the multiplier of value. The speakers highlighted the following:

Build a Plan : Approach engagement like any other business plan with metrics, accountability, and “S.M.A.R.T." goals.

Build Trust: Visibility breeds credibility. Credibility breeds Trust. Trust encourages Engagement.

Build Transparency: Keep communication simple and be sure that it’s helpful information.

Build Leaders: All hospitalists are leaders. Strong leadership skills promote effective communication across the system. Nurture leadership skills for the right level of leadership, to find the right seat on the bus.

Build Celebrations: Celebrate successes, and learn from failure. TH

Caring for patients in the inpatient setting is complex and often requires consultation from specialists. Yet the actual skill of obtaining a consult is rarely taught. Medical students and residents usually learn by trial and error, becoming targets of frustrated consultants and suffering humiliation and much anxiety. To facilitate communication between the primary team and the specialist, we propose that the student and/or resident start by asking the following questions.

1. Why Call This Consult?

To decide whether you need a consult, first determine the type. Consultations can be broken down into three different types: advice on diagnosis, advice on management, or arrangements for a specific procedure or test. Advice on diagnosis or management is typically required when a clinical issue has reached the bounds of knowledge, experience, or comfort zone of the team or physician (e.g., idiopathic leukocytosis). For procedures, a consultant who is licensed to perform the procedure may be required (e.g., endoscopy for GI bleed).

2. What Should Be Done before a Consult Is Requested?

First, ask yourself, “If I were the consultant, what would I want to know?” Before calling, put yourself in the shoes of the consultant and consider the available data carefully to develop your own hypotheses. For example, infectious disease consultants typically make judgments based on relevant culture data, current and/or past antibiotics, imaging, and signs or symptoms of active infection. Reading about the problem beforehand allows you to anticipate possible questions and consider additional studies that may be requested by the consultant. It also helps ascertain whether the consultation is actually necessary or targeted to the right team.

3. What Is the Clinical Question?

Bergus and colleagues found that a well-structured clinical question clearly identifies the treatment the primary doctor is proposing and the desired outcomes for the patient.1 For instance, rather than asking, “What should we do for this 75-year-old man with chest pain?”, a better question might be, “Will the addition of ranolazine increase exercise tolerance in our 75-year-old man with angina who is already taking a beta blocker and nitrates?” When both components are present, clinical questions are more likely to be answered.

4. How Do I Best Present the Case to My Consultant?

Requesting a consultation requires a succinct presentation that focuses on the aspects of the case most pertinent to the specialist. To do this, again put yourself in the shoes of the consultant. For example, a patient’s history of venous thromboembolism (VTE) will always be relevant to a hematologist, whereas a history of GERD may not be needed in your initial conversation. Limit the initial presentation to two to three minutes and organize using the four I’s:

1. Introduction: “My name is X with blue medicine team; I am calling to request a consult.”
2. Information: Patient name, location, medical record number, attending physician.
3. Inquiry: “I am requesting evaluation for an EGD in a patient with an upper GI bleed.”
4. Important items (the story): “Mr. X is a 55-year-old male with history of peptic ulcer disease presenting with abdominal pain.”

5. What Data Requests Should I Anticipate?

Have your clinical data easily accessible in case additional information is requested (i.e., keep the chart open when calling). If certain tests are predictably going to be needed by the specialist (e.g., renal ultrasound for a nephrologist), make sure that the results are available or in process. Also, be prepared to take notes if the consultant requests additional tests up front.

6. How Urgent Is the Consult?

Consultations can be emergent, urgent, or elective. Directly communicate any emergent or urgent consults in order to clarify the issues expeditiously. For more routine consults, consider delaying the call until enough laboratory data or imaging is available for the consultant to answer the question. Do not call a nonurgent consult at the end of the day or on a weekend.

7. Where Can I Meet with the Consultant to Discuss the Case?

Be available to your consultants by offering the fastest and most reliable means for them to get in touch with you. Take advantage of your consultants and learn from them. Be where they are: If looking at the blood smear, join them. If spinning the urine, ask to examine the sediment together. Discussing the case in person demonstrates your interest, engendering a more serious and perhaps expeditious consideration of your case. Finally, request seminal articles that have driven their decision to allow for more intelligent conversations in the future.

8. How Can I Nurture My Relationship with the Consulting Team?

The best relationships with consultants require give-and-take. Be a reliable source by providing accurate documentation of ongoing events, history and physical examination, and laboratory data in your notes. Understand consultant recommendations and summarize these in your plan. Avoid “Plan per Renal/GI/Cards/Heme, etc.” in your notes. Continue to think about the questions and issues and read on your own. If you are unclear about the recommendations, clarify them with the consulting team. Speaking with consultants is a learning opportunity; never forget to ask why they have made a certain recommendation. Avoid “chart wars” if there are points of disagreement with the plan or recommendations.

9. How Do I Close the Loop on the Consult?

Closing the communication loop is one of the most important aspects of the consult because it allows you to act on the recommendations. Remember that consultants are likely to be as busy as you are (if not busier). If the consult was urgent, call consultants directly for guidance. If it wasn’t urgent, look in the chart first for their note. Checking the chart later in the day could help to avoid unnecessary phone calls and increase your efficiency.

10. Am I Sure I Want a Curbside Consult?

In a curbside consult, you request advice of an expert who is neither in the presence of the patients nor has a therapeutic relationship with them. A study by Burden and colleagues in 2013 found that 55% of physicians offered different advice in formal consultation than in a curbside consultation, and 60% felt that formal consultation changed management.2 Similarly, Kuo and colleagues noted that 77% of subspecialists reported that important clinical findings were frequently missing from curbsides.3 Some recommend limiting curbsides to simple questions that don’t require consultants to assess multiple variables; as a courtesy, consider offering them the option of a formal consult. Ultimately, the decision to request a curbside consultation, and any consultation for that matter, should always be discussed with your attending physician.

Conclusion

Effective communication with consultants requires forethought and is an exercise in clinical reasoning of great educational value to students and residents. By considering the questions above, the consultative experience can be more productive for both the primary and consulting team and will enhance the care of the hospitalized patient. TH

Dr. Esquivel is a hospitalist in the Division of Hospital Medicine at Weill Cornell Medical College in New York City. Dr. Rendon is a hospitalist in the Division of Hospital Medicine at the University of New Mexico in Albuquerque.

References

1. Bergus GR, Randall CS, Sinift SD, Rosenthal DM. Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues? Arch Fam Med. 2000;9(6):541-547.

2. Burden M, Sarcone E, Keniston A, et al. Prospective comparison of curbside versus formal consultations. J Hosp Med. 2013;8(1):31-35.

3. Kuo D, Gifford DR, Stein MD. Curbside consultation practices and attitudes among primary care physicians and medical subspecialists. JAMA. 1998;280(10):905-909.

Caring for patients in the inpatient setting is complex and often requires consultation from specialists. Yet the actual skill of obtaining a consult is rarely taught. Medical students and residents usually learn by trial and error, becoming targets of frustrated consultants and suffering humiliation and much anxiety. To facilitate communication between the primary team and the specialist, we propose that the student and/or resident start by asking the following questions.

1. Why Call This Consult?

To decide whether you need a consult, first determine the type. Consultations can be broken down into three different types: advice on diagnosis, advice on management, or arrangements for a specific procedure or test. Advice on diagnosis or management is typically required when a clinical issue has reached the bounds of knowledge, experience, or comfort zone of the team or physician (e.g., idiopathic leukocytosis). For procedures, a consultant who is licensed to perform the procedure may be required (e.g., endoscopy for GI bleed).

2. What Should Be Done before a Consult Is Requested?

First, ask yourself, “If I were the consultant, what would I want to know?” Before calling, put yourself in the shoes of the consultant and consider the available data carefully to develop your own hypotheses. For example, infectious disease consultants typically make judgments based on relevant culture data, current and/or past antibiotics, imaging, and signs or symptoms of active infection. Reading about the problem beforehand allows you to anticipate possible questions and consider additional studies that may be requested by the consultant. It also helps ascertain whether the consultation is actually necessary or targeted to the right team.

3. What Is the Clinical Question?

Bergus and colleagues found that a well-structured clinical question clearly identifies the treatment the primary doctor is proposing and the desired outcomes for the patient.1 For instance, rather than asking, “What should we do for this 75-year-old man with chest pain?”, a better question might be, “Will the addition of ranolazine increase exercise tolerance in our 75-year-old man with angina who is already taking a beta blocker and nitrates?” When both components are present, clinical questions are more likely to be answered.

4. How Do I Best Present the Case to My Consultant?

Requesting a consultation requires a succinct presentation that focuses on the aspects of the case most pertinent to the specialist. To do this, again put yourself in the shoes of the consultant. For example, a patient’s history of venous thromboembolism (VTE) will always be relevant to a hematologist, whereas a history of GERD may not be needed in your initial conversation. Limit the initial presentation to two to three minutes and organize using the four I’s:

1. Introduction: “My name is X with blue medicine team; I am calling to request a consult.”
2. Information: Patient name, location, medical record number, attending physician.
3. Inquiry: “I am requesting evaluation for an EGD in a patient with an upper GI bleed.”
4. Important items (the story): “Mr. X is a 55-year-old male with history of peptic ulcer disease presenting with abdominal pain.”

5. What Data Requests Should I Anticipate?

Have your clinical data easily accessible in case additional information is requested (i.e., keep the chart open when calling). If certain tests are predictably going to be needed by the specialist (e.g., renal ultrasound for a nephrologist), make sure that the results are available or in process. Also, be prepared to take notes if the consultant requests additional tests up front.

6. How Urgent Is the Consult?

Consultations can be emergent, urgent, or elective. Directly communicate any emergent or urgent consults in order to clarify the issues expeditiously. For more routine consults, consider delaying the call until enough laboratory data or imaging is available for the consultant to answer the question. Do not call a nonurgent consult at the end of the day or on a weekend.

7. Where Can I Meet with the Consultant to Discuss the Case?

Be available to your consultants by offering the fastest and most reliable means for them to get in touch with you. Take advantage of your consultants and learn from them. Be where they are: If looking at the blood smear, join them. If spinning the urine, ask to examine the sediment together. Discussing the case in person demonstrates your interest, engendering a more serious and perhaps expeditious consideration of your case. Finally, request seminal articles that have driven their decision to allow for more intelligent conversations in the future.

8. How Can I Nurture My Relationship with the Consulting Team?

The best relationships with consultants require give-and-take. Be a reliable source by providing accurate documentation of ongoing events, history and physical examination, and laboratory data in your notes. Understand consultant recommendations and summarize these in your plan. Avoid “Plan per Renal/GI/Cards/Heme, etc.” in your notes. Continue to think about the questions and issues and read on your own. If you are unclear about the recommendations, clarify them with the consulting team. Speaking with consultants is a learning opportunity; never forget to ask why they have made a certain recommendation. Avoid “chart wars” if there are points of disagreement with the plan or recommendations.

9. How Do I Close the Loop on the Consult?

Closing the communication loop is one of the most important aspects of the consult because it allows you to act on the recommendations. Remember that consultants are likely to be as busy as you are (if not busier). If the consult was urgent, call consultants directly for guidance. If it wasn’t urgent, look in the chart first for their note. Checking the chart later in the day could help to avoid unnecessary phone calls and increase your efficiency.

10. Am I Sure I Want a Curbside Consult?

In a curbside consult, you request advice of an expert who is neither in the presence of the patients nor has a therapeutic relationship with them. A study by Burden and colleagues in 2013 found that 55% of physicians offered different advice in formal consultation than in a curbside consultation, and 60% felt that formal consultation changed management.2 Similarly, Kuo and colleagues noted that 77% of subspecialists reported that important clinical findings were frequently missing from curbsides.3 Some recommend limiting curbsides to simple questions that don’t require consultants to assess multiple variables; as a courtesy, consider offering them the option of a formal consult. Ultimately, the decision to request a curbside consultation, and any consultation for that matter, should always be discussed with your attending physician.

Conclusion

Effective communication with consultants requires forethought and is an exercise in clinical reasoning of great educational value to students and residents. By considering the questions above, the consultative experience can be more productive for both the primary and consulting team and will enhance the care of the hospitalized patient. TH

Dr. Esquivel is a hospitalist in the Division of Hospital Medicine at Weill Cornell Medical College in New York City. Dr. Rendon is a hospitalist in the Division of Hospital Medicine at the University of New Mexico in Albuquerque.

References

1. Bergus GR, Randall CS, Sinift SD, Rosenthal DM. Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues? Arch Fam Med. 2000;9(6):541-547.

2. Burden M, Sarcone E, Keniston A, et al. Prospective comparison of curbside versus formal consultations. J Hosp Med. 2013;8(1):31-35.

3. Kuo D, Gifford DR, Stein MD. Curbside consultation practices and attitudes among primary care physicians and medical subspecialists. JAMA. 1998;280(10):905-909.

Caring for patients in the inpatient setting is complex and often requires consultation from specialists. Yet the actual skill of obtaining a consult is rarely taught. Medical students and residents usually learn by trial and error, becoming targets of frustrated consultants and suffering humiliation and much anxiety. To facilitate communication between the primary team and the specialist, we propose that the student and/or resident start by asking the following questions.

1. Why Call This Consult?

To decide whether you need a consult, first determine the type. Consultations can be broken down into three different types: advice on diagnosis, advice on management, or arrangements for a specific procedure or test. Advice on diagnosis or management is typically required when a clinical issue has reached the bounds of knowledge, experience, or comfort zone of the team or physician (e.g., idiopathic leukocytosis). For procedures, a consultant who is licensed to perform the procedure may be required (e.g., endoscopy for GI bleed).

2. What Should Be Done before a Consult Is Requested?

First, ask yourself, “If I were the consultant, what would I want to know?” Before calling, put yourself in the shoes of the consultant and consider the available data carefully to develop your own hypotheses. For example, infectious disease consultants typically make judgments based on relevant culture data, current and/or past antibiotics, imaging, and signs or symptoms of active infection. Reading about the problem beforehand allows you to anticipate possible questions and consider additional studies that may be requested by the consultant. It also helps ascertain whether the consultation is actually necessary or targeted to the right team.

3. What Is the Clinical Question?

Bergus and colleagues found that a well-structured clinical question clearly identifies the treatment the primary doctor is proposing and the desired outcomes for the patient.1 For instance, rather than asking, “What should we do for this 75-year-old man with chest pain?”, a better question might be, “Will the addition of ranolazine increase exercise tolerance in our 75-year-old man with angina who is already taking a beta blocker and nitrates?” When both components are present, clinical questions are more likely to be answered.

4. How Do I Best Present the Case to My Consultant?

Requesting a consultation requires a succinct presentation that focuses on the aspects of the case most pertinent to the specialist. To do this, again put yourself in the shoes of the consultant. For example, a patient’s history of venous thromboembolism (VTE) will always be relevant to a hematologist, whereas a history of GERD may not be needed in your initial conversation. Limit the initial presentation to two to three minutes and organize using the four I’s:

1. Introduction: “My name is X with blue medicine team; I am calling to request a consult.”
2. Information: Patient name, location, medical record number, attending physician.
3. Inquiry: “I am requesting evaluation for an EGD in a patient with an upper GI bleed.”
4. Important items (the story): “Mr. X is a 55-year-old male with history of peptic ulcer disease presenting with abdominal pain.”

5. What Data Requests Should I Anticipate?

Have your clinical data easily accessible in case additional information is requested (i.e., keep the chart open when calling). If certain tests are predictably going to be needed by the specialist (e.g., renal ultrasound for a nephrologist), make sure that the results are available or in process. Also, be prepared to take notes if the consultant requests additional tests up front.

6. How Urgent Is the Consult?

Consultations can be emergent, urgent, or elective. Directly communicate any emergent or urgent consults in order to clarify the issues expeditiously. For more routine consults, consider delaying the call until enough laboratory data or imaging is available for the consultant to answer the question. Do not call a nonurgent consult at the end of the day or on a weekend.

7. Where Can I Meet with the Consultant to Discuss the Case?

Be available to your consultants by offering the fastest and most reliable means for them to get in touch with you. Take advantage of your consultants and learn from them. Be where they are: If looking at the blood smear, join them. If spinning the urine, ask to examine the sediment together. Discussing the case in person demonstrates your interest, engendering a more serious and perhaps expeditious consideration of your case. Finally, request seminal articles that have driven their decision to allow for more intelligent conversations in the future.

8. How Can I Nurture My Relationship with the Consulting Team?

The best relationships with consultants require give-and-take. Be a reliable source by providing accurate documentation of ongoing events, history and physical examination, and laboratory data in your notes. Understand consultant recommendations and summarize these in your plan. Avoid “Plan per Renal/GI/Cards/Heme, etc.” in your notes. Continue to think about the questions and issues and read on your own. If you are unclear about the recommendations, clarify them with the consulting team. Speaking with consultants is a learning opportunity; never forget to ask why they have made a certain recommendation. Avoid “chart wars” if there are points of disagreement with the plan or recommendations.

9. How Do I Close the Loop on the Consult?

Closing the communication loop is one of the most important aspects of the consult because it allows you to act on the recommendations. Remember that consultants are likely to be as busy as you are (if not busier). If the consult was urgent, call consultants directly for guidance. If it wasn’t urgent, look in the chart first for their note. Checking the chart later in the day could help to avoid unnecessary phone calls and increase your efficiency.

10. Am I Sure I Want a Curbside Consult?

In a curbside consult, you request advice of an expert who is neither in the presence of the patients nor has a therapeutic relationship with them. A study by Burden and colleagues in 2013 found that 55% of physicians offered different advice in formal consultation than in a curbside consultation, and 60% felt that formal consultation changed management.2 Similarly, Kuo and colleagues noted that 77% of subspecialists reported that important clinical findings were frequently missing from curbsides.3 Some recommend limiting curbsides to simple questions that don’t require consultants to assess multiple variables; as a courtesy, consider offering them the option of a formal consult. Ultimately, the decision to request a curbside consultation, and any consultation for that matter, should always be discussed with your attending physician.

Conclusion

Effective communication with consultants requires forethought and is an exercise in clinical reasoning of great educational value to students and residents. By considering the questions above, the consultative experience can be more productive for both the primary and consulting team and will enhance the care of the hospitalized patient. TH

Dr. Esquivel is a hospitalist in the Division of Hospital Medicine at Weill Cornell Medical College in New York City. Dr. Rendon is a hospitalist in the Division of Hospital Medicine at the University of New Mexico in Albuquerque.

References

1. Bergus GR, Randall CS, Sinift SD, Rosenthal DM. Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues? Arch Fam Med. 2000;9(6):541-547.

2. Burden M, Sarcone E, Keniston A, et al. Prospective comparison of curbside versus formal consultations. J Hosp Med. 2013;8(1):31-35.

3. Kuo D, Gifford DR, Stein MD. Curbside consultation practices and attitudes among primary care physicians and medical subspecialists. JAMA. 1998;280(10):905-909.

NEW YORK (Reuters Health) - Clinical practice in management of early-onset sepsis (EOS) in newborns varies widely across Europe, North America and Asia, new survey results show.

National guidelines also disagree on when to start antibiotics in low-risk situations, and how to decide to stop therapy in high-risk scenarios, Dr. Wendy van Herk of Erasmus MC University Medical Center-Sophia Children's Hospital in Rotterdam, the Netherlands, and colleagues found."

A discussion leading to terms of a threshold to treat neonates with low infection risk, prospective studies ofstrategies regarding early discontinuation of unnecessary antibiotic therapy with safety endpoints acknowledging different backgrounds of health care systems, and clear and concise guidelines followed by research to study the impact are mandatory to improve management of term and late preterm infants at risk for EOS," they write in their report, online January 13 in The Pediatric Infectious Disease Journal.

Up to 15% of term and late-preterm neonates are evaluated for suspected EOS, and 10% receive intravenous antibiotics within the first three days of life, the researchers note. But the incidence of culture-proven EOS in term and late-preterm newborns is less than 0.1%, they add.

To investigate current management of suspected EOS, the researchers surveyed pediatricians and neonatologists and reviewed guidelines from Canada, the United States, the United Kingdom, Switzerland and Belgium. A total of 439 clinicians responded to the survey.

In response to a question about whether they would start antibiotic treatment in a scenario rated "low risk" for EOS, 29% of physicians said they would, 26% would not, and 45% said they would start treatment if the patients' laboratory markers were abnormal. Nearly all of the respondents (99%) said they would initiate antibiotics in a high-risk scenario.

In the low-risk situation, 89% said they would stop antibiotic treatment before 72 hours. In the high-risk scenario, 35% said they would stop antibiotics before 72 hours, 56% said they would continue treatment for five to seven days, and 9% said they would treat patients for more than seven days.

Overall, 31% of the survey respondents said they would base their decision to start antibiotic treatment on laboratory investigations, while 72% said they would do so when deciding to continue treatment. Most said they would use complete blood count (CBC) and C-reactive protein (CRP), while a small minority said they would use newer inflammation markers including procalcitonin (PCT) and interleukins.

While all the guidelines reviewed recommended treating newborns with clinical signs indicating infection, and re-evaluating whether patients needed more antibiotics at 36 to 48 hours, they did not provide specific advice on treatment when newborns had prolonged clinical signs of infection or high levels of infection markers. All guidelines recommended using CBC or CRP, while only one included PCT.

Dr. van Herk and colleagues also compared the guidelines for each country with the survey responses of physicians from that country, and found most followed national guidelines on when to start or discontinue antibiotics.

"The diversity with regards to duration of antibiotic therapy in higher risk situations raises the question, what are safe strategies to minimize duration of antibiotic therapy without under-treatment of truly septic neonates?" the authors write. "Currently, the duration of antibiotic therapy is controversial even for proven infection. Prospective, international, multicenter trials studying newer infection markers with a safety endpoint may be helpful in answering this question."

NEW YORK (Reuters Health) - Clinical practice in management of early-onset sepsis (EOS) in newborns varies widely across Europe, North America and Asia, new survey results show.

National guidelines also disagree on when to start antibiotics in low-risk situations, and how to decide to stop therapy in high-risk scenarios, Dr. Wendy van Herk of Erasmus MC University Medical Center-Sophia Children's Hospital in Rotterdam, the Netherlands, and colleagues found."

A discussion leading to terms of a threshold to treat neonates with low infection risk, prospective studies ofstrategies regarding early discontinuation of unnecessary antibiotic therapy with safety endpoints acknowledging different backgrounds of health care systems, and clear and concise guidelines followed by research to study the impact are mandatory to improve management of term and late preterm infants at risk for EOS," they write in their report, online January 13 in The Pediatric Infectious Disease Journal.

Up to 15% of term and late-preterm neonates are evaluated for suspected EOS, and 10% receive intravenous antibiotics within the first three days of life, the researchers note. But the incidence of culture-proven EOS in term and late-preterm newborns is less than 0.1%, they add.

To investigate current management of suspected EOS, the researchers surveyed pediatricians and neonatologists and reviewed guidelines from Canada, the United States, the United Kingdom, Switzerland and Belgium. A total of 439 clinicians responded to the survey.

In response to a question about whether they would start antibiotic treatment in a scenario rated "low risk" for EOS, 29% of physicians said they would, 26% would not, and 45% said they would start treatment if the patients' laboratory markers were abnormal. Nearly all of the respondents (99%) said they would initiate antibiotics in a high-risk scenario.

In the low-risk situation, 89% said they would stop antibiotic treatment before 72 hours. In the high-risk scenario, 35% said they would stop antibiotics before 72 hours, 56% said they would continue treatment for five to seven days, and 9% said they would treat patients for more than seven days.

Overall, 31% of the survey respondents said they would base their decision to start antibiotic treatment on laboratory investigations, while 72% said they would do so when deciding to continue treatment. Most said they would use complete blood count (CBC) and C-reactive protein (CRP), while a small minority said they would use newer inflammation markers including procalcitonin (PCT) and interleukins.

While all the guidelines reviewed recommended treating newborns with clinical signs indicating infection, and re-evaluating whether patients needed more antibiotics at 36 to 48 hours, they did not provide specific advice on treatment when newborns had prolonged clinical signs of infection or high levels of infection markers. All guidelines recommended using CBC or CRP, while only one included PCT.

Dr. van Herk and colleagues also compared the guidelines for each country with the survey responses of physicians from that country, and found most followed national guidelines on when to start or discontinue antibiotics.

"The diversity with regards to duration of antibiotic therapy in higher risk situations raises the question, what are safe strategies to minimize duration of antibiotic therapy without under-treatment of truly septic neonates?" the authors write. "Currently, the duration of antibiotic therapy is controversial even for proven infection. Prospective, international, multicenter trials studying newer infection markers with a safety endpoint may be helpful in answering this question."

NEW YORK (Reuters Health) - Clinical practice in management of early-onset sepsis (EOS) in newborns varies widely across Europe, North America and Asia, new survey results show.

National guidelines also disagree on when to start antibiotics in low-risk situations, and how to decide to stop therapy in high-risk scenarios, Dr. Wendy van Herk of Erasmus MC University Medical Center-Sophia Children's Hospital in Rotterdam, the Netherlands, and colleagues found."

A discussion leading to terms of a threshold to treat neonates with low infection risk, prospective studies ofstrategies regarding early discontinuation of unnecessary antibiotic therapy with safety endpoints acknowledging different backgrounds of health care systems, and clear and concise guidelines followed by research to study the impact are mandatory to improve management of term and late preterm infants at risk for EOS," they write in their report, online January 13 in The Pediatric Infectious Disease Journal.

Up to 15% of term and late-preterm neonates are evaluated for suspected EOS, and 10% receive intravenous antibiotics within the first three days of life, the researchers note. But the incidence of culture-proven EOS in term and late-preterm newborns is less than 0.1%, they add.

To investigate current management of suspected EOS, the researchers surveyed pediatricians and neonatologists and reviewed guidelines from Canada, the United States, the United Kingdom, Switzerland and Belgium. A total of 439 clinicians responded to the survey.

In response to a question about whether they would start antibiotic treatment in a scenario rated "low risk" for EOS, 29% of physicians said they would, 26% would not, and 45% said they would start treatment if the patients' laboratory markers were abnormal. Nearly all of the respondents (99%) said they would initiate antibiotics in a high-risk scenario.

In the low-risk situation, 89% said they would stop antibiotic treatment before 72 hours. In the high-risk scenario, 35% said they would stop antibiotics before 72 hours, 56% said they would continue treatment for five to seven days, and 9% said they would treat patients for more than seven days.

Overall, 31% of the survey respondents said they would base their decision to start antibiotic treatment on laboratory investigations, while 72% said they would do so when deciding to continue treatment. Most said they would use complete blood count (CBC) and C-reactive protein (CRP), while a small minority said they would use newer inflammation markers including procalcitonin (PCT) and interleukins.

While all the guidelines reviewed recommended treating newborns with clinical signs indicating infection, and re-evaluating whether patients needed more antibiotics at 36 to 48 hours, they did not provide specific advice on treatment when newborns had prolonged clinical signs of infection or high levels of infection markers. All guidelines recommended using CBC or CRP, while only one included PCT.

Dr. van Herk and colleagues also compared the guidelines for each country with the survey responses of physicians from that country, and found most followed national guidelines on when to start or discontinue antibiotics.

"The diversity with regards to duration of antibiotic therapy in higher risk situations raises the question, what are safe strategies to minimize duration of antibiotic therapy without under-treatment of truly septic neonates?" the authors write. "Currently, the duration of antibiotic therapy is controversial even for proven infection. Prospective, international, multicenter trials studying newer infection markers with a safety endpoint may be helpful in answering this question."

SAN DIEGO—The Society of Hospital Medicine (SHM) today named three new Masters in Hospital Medicine at HM16, the largest meeting dedicated to the hospital medicine specialty. The Master in Hospital Medicine (MHM) designation was introduced in 2010 to honor those who have uniquely distinguished themselves in hospital medicine through excellence in the field and healthcare as a whole.

“As hospital medicine continues to evolve, we look to experts in the field to lead us into the future with their innovation and vision,” SHM President Brian Harte, MD, SFHM, says. “These accomplished individuals have played foundational roles in hospital medicine’s growth and success and continue to ensure hospitalists are equipped with the tools and resources they need to provide the highest quality of patient care.”

SHM is proud to announce the following MHMs for their outstanding contributions:

• Tina L. Budnitz, MPH, MHM, for her leadership in advancing the hospital medicine movement and SHM. Throughout her time with SHM, Budnitz has led the development of the Core Competencies for Hospital Medicine to define the skills of a practicing hospitalist, launched Project BOOST, a mentored implementation program to improve care transitions that was recognized with the 2012 John M. Eisenberg Patient Safety and Quality Award and assisted in the development of SHM’s Leadership Academy and Certificate of Leadership Program, designed to build the healthcare leaders of tomorrow.
• Eric E. Howell, MD, MHM, Chief of the Division of Hospital Medicine at Johns Hopkins Bayview Medical Center in Baltimore, MD, in recognition of his foundational leadership in the hospital medicine movement and SHM. Dr. Howell has been instrumental in managing and implementing change in the hospital, including conducting research on the relationship between the emergency department and medicine floors as well as improving communication, throughput and patient outcomes. A past President of SHM, Dr. Howell serves as the Senior Physician Advisor to SHM’s Center for Hospital Innovation and Improvement and has mentored numerous hospitals and hospital medicine programs in more than six countries.
• Gregory Maynard, MD, MSc, MHM, Chief Quality Officer at the University of California Davis Medical Center in Sacramento, CA, in honor of his leadership in local, regional and national quality improvement efforts and related contributions to SHM’s quality improvement programs. A longtime member of the SHM Hospital Quality and Patient Safety Committee, Dr. Maynard played an integral role in creating and leading SHM’s mentored implementation programs to enhance care transitions, improve glycemic control and prevent venous thromboembolism (VTE). Dr. Maynard is nationally recognized in each of these areas, making significant contributions to the medical community.

For details on SHM’s fellowship designations, visit www.hospitalmedicine.org/fellows.

SAN DIEGO—The Society of Hospital Medicine (SHM) today named three new Masters in Hospital Medicine at HM16, the largest meeting dedicated to the hospital medicine specialty. The Master in Hospital Medicine (MHM) designation was introduced in 2010 to honor those who have uniquely distinguished themselves in hospital medicine through excellence in the field and healthcare as a whole.

“As hospital medicine continues to evolve, we look to experts in the field to lead us into the future with their innovation and vision,” SHM President Brian Harte, MD, SFHM, says. “These accomplished individuals have played foundational roles in hospital medicine’s growth and success and continue to ensure hospitalists are equipped with the tools and resources they need to provide the highest quality of patient care.”

SHM is proud to announce the following MHMs for their outstanding contributions:

• Tina L. Budnitz, MPH, MHM, for her leadership in advancing the hospital medicine movement and SHM. Throughout her time with SHM, Budnitz has led the development of the Core Competencies for Hospital Medicine to define the skills of a practicing hospitalist, launched Project BOOST, a mentored implementation program to improve care transitions that was recognized with the 2012 John M. Eisenberg Patient Safety and Quality Award and assisted in the development of SHM’s Leadership Academy and Certificate of Leadership Program, designed to build the healthcare leaders of tomorrow.
• Eric E. Howell, MD, MHM, Chief of the Division of Hospital Medicine at Johns Hopkins Bayview Medical Center in Baltimore, MD, in recognition of his foundational leadership in the hospital medicine movement and SHM. Dr. Howell has been instrumental in managing and implementing change in the hospital, including conducting research on the relationship between the emergency department and medicine floors as well as improving communication, throughput and patient outcomes. A past President of SHM, Dr. Howell serves as the Senior Physician Advisor to SHM’s Center for Hospital Innovation and Improvement and has mentored numerous hospitals and hospital medicine programs in more than six countries.
• Gregory Maynard, MD, MSc, MHM, Chief Quality Officer at the University of California Davis Medical Center in Sacramento, CA, in honor of his leadership in local, regional and national quality improvement efforts and related contributions to SHM’s quality improvement programs. A longtime member of the SHM Hospital Quality and Patient Safety Committee, Dr. Maynard played an integral role in creating and leading SHM’s mentored implementation programs to enhance care transitions, improve glycemic control and prevent venous thromboembolism (VTE). Dr. Maynard is nationally recognized in each of these areas, making significant contributions to the medical community.

For details on SHM’s fellowship designations, visit www.hospitalmedicine.org/fellows.

SAN DIEGO—The Society of Hospital Medicine (SHM) today named three new Masters in Hospital Medicine at HM16, the largest meeting dedicated to the hospital medicine specialty. The Master in Hospital Medicine (MHM) designation was introduced in 2010 to honor those who have uniquely distinguished themselves in hospital medicine through excellence in the field and healthcare as a whole.

“As hospital medicine continues to evolve, we look to experts in the field to lead us into the future with their innovation and vision,” SHM President Brian Harte, MD, SFHM, says. “These accomplished individuals have played foundational roles in hospital medicine’s growth and success and continue to ensure hospitalists are equipped with the tools and resources they need to provide the highest quality of patient care.”

SHM is proud to announce the following MHMs for their outstanding contributions:

• Tina L. Budnitz, MPH, MHM, for her leadership in advancing the hospital medicine movement and SHM. Throughout her time with SHM, Budnitz has led the development of the Core Competencies for Hospital Medicine to define the skills of a practicing hospitalist, launched Project BOOST, a mentored implementation program to improve care transitions that was recognized with the 2012 John M. Eisenberg Patient Safety and Quality Award and assisted in the development of SHM’s Leadership Academy and Certificate of Leadership Program, designed to build the healthcare leaders of tomorrow.
• Eric E. Howell, MD, MHM, Chief of the Division of Hospital Medicine at Johns Hopkins Bayview Medical Center in Baltimore, MD, in recognition of his foundational leadership in the hospital medicine movement and SHM. Dr. Howell has been instrumental in managing and implementing change in the hospital, including conducting research on the relationship between the emergency department and medicine floors as well as improving communication, throughput and patient outcomes. A past President of SHM, Dr. Howell serves as the Senior Physician Advisor to SHM’s Center for Hospital Innovation and Improvement and has mentored numerous hospitals and hospital medicine programs in more than six countries.
• Gregory Maynard, MD, MSc, MHM, Chief Quality Officer at the University of California Davis Medical Center in Sacramento, CA, in honor of his leadership in local, regional and national quality improvement efforts and related contributions to SHM’s quality improvement programs. A longtime member of the SHM Hospital Quality and Patient Safety Committee, Dr. Maynard played an integral role in creating and leading SHM’s mentored implementation programs to enhance care transitions, improve glycemic control and prevent venous thromboembolism (VTE). Dr. Maynard is nationally recognized in each of these areas, making significant contributions to the medical community.

For details on SHM’s fellowship designations, visit www.hospitalmedicine.org/fellows.